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患有多囊卵巢综合征的生殖期和绝经年龄女性的心血管事件:一项系统评价和荟萃分析。

Cardiovascular events among reproductive and menopausal age women with polycystic ovary syndrome: a systematic review and meta-analysis.

作者信息

Ramezani Tehrani Fahimeh, Amiri Mina, Behboudi-Gandevani Samira, Bidhendi-Yarandi Razieh, Carmina Enrico

机构信息

Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.

出版信息

Gynecol Endocrinol. 2020 Jan;36(1):12-23. doi: 10.1080/09513590.2019.1650337. Epub 2019 Aug 6.

Abstract

This study aimed to evaluate the prevalence (P)/hazard ratio (HR) of cardiovascular (CV) events among reproductive age and menopausal age women with polycystic ovary syndrome (PCOS) in comparison with healthy controls. PubMed, Scopus, ScienceDirect, Web of science, and Google scholar were searched for retrieving observational studies published up to April 2018 investigating CV events in patients with PCOS. The primary outcomes were a composite outcome of CV events [including coronary arterial disease (CAD), cardiovascular disease (CVD), myocardial infarction (MI), angina, heart failure, and ischemic heart disease] and mortality due to CV events; secondary outcomes were specific CVD events, including cerebrovascular disease, CAD, CVD, MI, angina, heart failure, ischemic heart disease, and stroke. In this meta-analysis, both fixed and random effect models were used. Potential sources of heterogeneity were explored by meta-regression and subgroup analyses. Sixteen studies including 12 population-based were analyzed for the meta-analysis. Results showed that the pooled HRs of CV events in PCOS patients of reproductive age and in menopausal/aging women were higher than healthy controls (pooled HR: 1.38, 95% CI: 1.12-1.71) and (pooled HR: 1.53, 95% CI: 1.15, 2.04), respectively. Compared to healthy controls, analysis of population-based studies revealed that the HR of CV events increased only in reproductive age PCOS patients (1.43-fold, 95% CI: 1.27, 1.61), whereas the difference was not statistically significant when comparing menopausal/aging PCOS patients to healthy controls (1.03-fold, 95% CI: 0.41, 2.59). Sufficient data were not available for comparing the HRs of mortality due to CV events between the two PCOS age groups. Mainly based on population-based study, we found a greater risk of CV events in reproductive aged but not in menopausal/aging PCOS women, suggesting that having a history of PCOS during reproductive ages may not be an important risk factor for developing events in later life. This is a preliminary assumption and needs to be reevaluated by further comprehensive cohort studies of longer duration, initiated in the reproductive period, considering all known CVD risk factors.

摘要

本研究旨在评估多囊卵巢综合征(PCOS)的育龄期和绝经年龄女性与健康对照相比,心血管(CV)事件的患病率(P)/风险比(HR)。检索了PubMed、Scopus、ScienceDirect、Web of science和谷歌学术,以获取截至2018年4月发表的关于调查PCOS患者CV事件的观察性研究。主要结局是CV事件的复合结局[包括冠状动脉疾病(CAD)、心血管疾病(CVD)、心肌梗死(MI)、心绞痛、心力衰竭和缺血性心脏病]以及CV事件导致的死亡率;次要结局是特定的CVD事件,包括脑血管疾病、CAD、CVD、MI、心绞痛、心力衰竭、缺血性心脏病和中风。在这项荟萃分析中,使用了固定效应模型和随机效应模型。通过meta回归和亚组分析探索异质性的潜在来源。对16项研究(包括12项基于人群的研究)进行了荟萃分析。结果显示,PCOS育龄期患者和绝经/老年女性的CV事件合并HR高于健康对照,分别为(合并HR:1.38,95%CI:1.12 - 1.71)和(合并HR:1.53,95%CI:1.15,2.04)。与健康对照相比,基于人群的研究分析显示,CV事件的HR仅在PCOS育龄期患者中增加(1.43倍,95%CI:1.27,1.61),而将PCOS绝经/老年患者与健康对照相比时,差异无统计学意义(1.03倍,95%CI:0.41,2.59)。没有足够的数据来比较两个PCOS年龄组之间CV事件导致的死亡率的HR。主要基于人群的研究,我们发现PCOS育龄期女性发生CV事件的风险更大,而绝经/老年PCOS女性则不然,这表明在育龄期有PCOS病史可能不是晚年发生CV事件的重要风险因素。这是一个初步假设,需要通过在生殖期开始的、考虑所有已知CVD风险因素的、持续时间更长的进一步综合队列研究进行重新评估。

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